Reply: The Solar System Model for the Reconstructive Ladder

Abstract

Sir: “Exploration, discovery, and creative scientific research are the keys to new knowledge, and essential toward understanding our origins and destiny.”1 This statement is guiding the future of the National Aeronautics and Space Administration. It also applies to our stimulating speciality perfectly. It is with great pleasure that we acknowledge the recent interest of ideas concerning the various reconstructive options that we can offer our patients in need today. The recent stimulating letter by Valentina Giordano et al. from Italy entitled “The Solar System Model for the Reconstructive Ladder” in the Journal again highlights the fundamental achievements of current plastic and reconstructive surgery.2 The current momentum in terms of conceptual thinking in reconstructive surgery appears to drift somehow into outer space, as reflected by the concept of the “reconstructive matrix” proposed by Erba et al. in 2010 in this Journal.3 Including the concept of reconstructive stages with maturation of the surgeon by Wong and Niranjan in 2008,4 and our “reconstructive clockwork” in 2010,5 it seems that with the evolving reconstructive techniques including acellular dermal matrices, composite tissue allotransplantation, tissue engineering and regeneration, and robotics, an increased complexity of procedures and surgical skills is mandatory. As far as the proposed reconstructive solar system is concerned, the surgeon in the center of the Milky Way has been assigned an extraordinary role; however, at least in our humble perception, the patient might better fit in the center of our common reconstructive efforts to obtain the best clinical result. Thus, we are in the midst of the discussion of who should be in the center of the universe, the surgeon or the patient. Likewise, Nicolaus Copernicus was involved in some discussion while proposing the heliocentric cosmology in his publication De Revolutionibus Orbium Coelestium in 1543. Giordano et al. state that “the planets, whose orbits are closer to the core, represent the most simple treatments, and often the most used ones, in medical practice.” We would like to question, for example, whether using acellular dermal matrices to represent the Earth in their concept is more often used than local flaps (Mars) or free flaps (Saturn). Considering our closest neighbors, Venus (skin grafting), being close in size to Earth but 400°C warmer because of greenhouse gases, or Mars (local flap) with its carbon dioxide atmosphere, skin grafting and local flaps are fundamental, long-standing techniques in plastic and reconstructive surgery. Mercury as a planet, representing direct closure, is the smallest and fastest moving planet in our solar system, with no natural satellites and almost no atmosphere. Besides, Project Mercury was the name of the first human spaceflight program of the United States from 1959 to 1963, followed by the Gemini and Apollo programs. Thus, direct closure as probably the fastest way to achieve defect closure is reiterated by the metaphor Mercury, the Roman symbol for speed. From an astronomical point of view, we have to correct the authors that Pluto is currently classified as a dwarf planet and no longer as a planet, which was changed in 2006 by the International Astronomical Union because it lacks the gravitational muscle to sweep up or scatter objects near its orbit. Karsten Knobloch, M.D., Ph.D. Peter M. Vogt, M.D., Ph.D. Plastic, Hand, and Reconstructive Surgery Hannover Medical School Hannover, Germany